Cath Lab Digest

  Obstructive defecation syndrome (ODS) is a complicated-sounding term for chronic constipation. It involves difficulty in passing stool, hard stool, straining for more than 15 minutes, or incomplete evacuation occurring at least weekly and continually for 6 months or more. An interdisciplinary team at the University of California San Francisco (UCSF) analyzed data from the Reproductive Risks for Incontinence Study at Kaiser (a population-based cohort of racially diverse women, 40 to 69 years old) and determined a 12.3% ODS prevalence in women — ie, ODS is a common occurrence in middle-aged women. Women in the database who had undergone laparoscopic/vaginal hysterectomies or surgery for pelvic organ prolapse or urinary incontinence had nearly twice the risk of weekly obstructive defecation, signaling a direct connection between ODS and underlying pelvic floor disorders.¹

Prevalence of Urge Incontinence

  An estimated 17 million community-dwelling adults in the US have daily urinary incontinence (UI), and an additional 33 million suffer from the overlapping condition, overactive bladder (OAB).¹ Although UI and OAB occur far more frequently in women than men, symptoms become more prevalent with advancing age, the gender gap closing in the elderly.² Whether older persons are homebound or nursing facility residents, more than half in either setting are incontinent. Incontinence represents one of the leading common diagnoses among the aged and one of the top reasons for placing an individual in an institutional residence where care is provided by staff.³

  As a sequel to “Informed Decisions for Improved Patient Safety” (Ostomy Wound Manage. 2011;57[9]:22-23), it is timely to make the case for a patient-centered process that focuses on expectations, effective intervention and care, and desired outcomes regarding vaginal mesh.

  Vaginal mesh used in pelvic surgery for treating stress urinary incontinence (SUI) and pelvic organ prolapse (POP) has received increasing attention, largely because of growing vocal complaints from patients (including men with hernia repair) experiencing chronic pain, urinary tract infections, and other discomfort following surgery. This attention influenced the Food and Drug Administration’s¹ (FDA) 2008 decision to issue a public warning about mesh, most of which utilizes polypropylene, a common biocompatible material used widely for sutures and other implanted devices. When complaints continued to increase and attorneys swarmed to file wrongful injury lawsuits, the FDA issued a stronger communication² on July 13, 2011, regarding complications from prolapse surgery using mesh “kits.”

  The soaring prevalence of obesity in the past decade has forced healthcare providers to pay increasing attention to the unique needs of the obese patient. Not the least of these needs is skin care and the risk of moisture-associated skin damage, most often diagnosed as intertriginous dermatitis (intertrigo). Obese patients are particularly vulnerable because the natural cooling mechanisms of their bodies are compromised, making perspiration a virtual constant. In addition, their body mass can limit mobility.

The National Association For Continence is a national, private, non-profit organization dedicated to improving the quality of life of people with incontinence. The NAFC’s purpose is to be the leading source for public education and advocacy about the causes, prevention, diagnosis, treatments, and management alternatives for incontinence. This article was not subject to the Ostomy Wound Management peer-review process.